title: Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.
abstract: OBJECTIVE
  To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.
  
  
  METHODS
  Service development, pilot evaluation study.
  
  
  METHODS
  Regional and remote areas of the state of New South Wales, Australia.
  
  
  METHODS
  Persons with SCI, caregivers, and health professionals.
  
  
  METHODS
  Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.
  
  
  METHODS
  Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.
  
  
  RESULTS
  Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.
  
  
  CONCLUSIONS
  Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.
authors.affiliation: Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, Sydney, Australia. j.middleton@usyd.edu.au
authors.forename: James W
authors.initials: JW
authors.lastname: Middleton
authors.forename: Melissa
authors.initials: M
authors.lastname: McCormick
authors.forename: Stella
authors.initials: S
authors.lastname: Engel
authors.forename: Susan B
authors.initials: SB
authors.lastname: Rutkowski
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
authors.forename: Peter
authors.initials: P
authors.lastname: Harradine
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Johnson
authors.forename: David
authors.initials: D
authors.lastname: Andrews
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009517:New South Wales; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*